Today we take an unflinching look at the surprising ways racism affects Black and African American people's mental health, from changing the way they see themselves to passing trauma down through generations.
Some Savvy Psychologist listeners have rightfully wondered why a mental health podcast has been silent on racism for a while. After all, racism cuts deeply into mental health, and it’s impossible to truly talk about one without the other. And in 2020, of all years, the many wounds of racism are publicly opened, again and again, reminding those of us who are privileged that people who experience racism don’t get to look away or forget.
Structural racism is the very picture of chronic trauma.
Racism is a topic too big and too important to cover reactively. Now, knowing that there is still much to learn, I'm here with a three-episode series on racism and mental health.
In this series, we focus specifically on the Black and African American experience. Of course, racism affects many other groups too, including non-Black groups and people of African descent around the world. My own cultural frame of reference is informed by what's happening in the U.S., and with such a complex topic, I thought it would be most productive to mostly hone in on one geographic area and one racial group. So, today, I'll be using the term Black broadly to encompass Black and African people who experience racism around the globe, and the terms "Black American" and "African American" to talk about research that specifically focuses on these groups.
Let's start here with the groundwork: How does racism affect Black and African American mental health?
Racism is detrimental to mental health
It may seem obvious that experiencing racism would be detrimental to mental health. After all, racism is the totality of ways that society discriminates and commits violence against Black people. It withholds justice, fairness, and resources. It marginalizes and gaslights. Structural racism is the very picture of chronic trauma.
But our understanding of the effects of racism goes beyond intuitive knowledge—there's research to support it. A 2018 briefing paper by the Synergi Collaborative Center introduced the existing research well. In brief, experiencing racism makes a person more likely to have depression, psychosis, and substance misuse.
Digging in with more detail, we find some interesting patterns. In 2015, a group of British researchers pooled data from almost 300 studies into one mega-study. They found that experiencing racism is associated with poorer physical and mental health. The negative effect on mental health (including depression, anxiety, and psychological stress) was especially strong. A particularly interesting pattern: For some health outcomes, having more education tends to protect people from racism’s negative consequences. But this is not true for mental health. In other words, even highly educated Black people suffer the negative mental health effects of racism.
Racism’s effects on mental health start early in life. For kids and adolescents, experiencing racism comes with more depressive symptoms, lower self-esteem, and more “acting out” behavior problems. Even when kids don't directly experience racism, their parents’ experience of discrimination makes the kids more likely to have anxiety and depression. In teens, over a hundred studies have found that experiencing racism is significantly associated with poorer mental health.
At this point, the question of "if" racism affects mental health has been clearly answered. The more interesting question is "how."
How does racism hurt Black and African American mental health?
Scholars on this topic have discussed a number of ways that racism can affect mental health. We’ll focus on five today:
1. Structural racism decreases the fundamental ingredients for mental health
Structural racism refers to the large-scale forces that keep Black Americans from getting fair treatment and adequate resources. It affects them not only where they live, but at work and school, and in the criminal justice system. It affects how they receive healthcare, and touches their lives in many other ways that are crucial to wellbeing.
Black Americans have shorter sleep, less deep sleep, and worse quality sleep.
Let’s take a closer look at just one example of how structural racism can affect one of the basic ingredients for mental health—sleep. Sleep is extremely important for good mental health. Not getting enough good quality sleep is related to just about every bad mental health outcome.
Black Americans have shorter sleep, less deep sleep, and worse quality sleep. Sleep researchers who specialize in sleep health disparities have looked into how likely different groups are to be short sleepers—that is, to regularly get less than 6 hours of sleep per night. Black Americans are five times as likely to be short sleepers than white Americans. Black men, who have the shortest sleep, get almost one-and-a-half fewer hours of sleep per night than white women. In part, this is because Black Americans are more likely to live in poorer neighborhoods with more noise and light. In fact, when you look at people living in similar environments, there is less of a racial difference.
For Black Americans, a systemic sleep disadvantage is also a systemic mental health disadvantage.
If you’re trying to maintain good mental health, not getting good sleep is like not having flour when you’re baking a cake. Sleep is a crucial ingredient for mental health. So, for Black Americans, a systemic sleep disadvantage is also a systemic mental health disadvantage.
2. Racism changes the way you experience success
Racism is extremely stressful. The nature of racism is that even if you do everything right, you may not get what you’ve earned. You may earn a higher degree and become a professor, but if you're Black, people may still often assume you’re the janitor. Your child may be bright, polite, and friendly, but if she's Black, her teacher may still perceive her as disrespectful or a slow learner because of systemic bias. You may put your empty hands up to show that you’re not a threat and still be a victim of brutality.
When the effort-reward connection is shattered time and again, a person begins to lose their sense of control over their life and fate.
And it’s not only each individual racist encounter that causes stress. These add up to be more than the sum of their parts, because when the effort-reward connection is shattered time and again, a person begins to lose their sense of control over their life and fate.
Think of it this way: If you work very hard, respect authority, and treat others well, you will live a decent life and be respected by others, right? What if you constantly try, but somehow, you never get that sense of safety and respect? This feeling of powerlessness has been linked over and over again to depression.
3. Racism changes the way you see yourself
Another sad consequence of repeatedly experiencing racism is that a person might start to believe racial stereotypes about themselves.
For marginalized people, internalizing society’s negative attitudes about them creates stress, lowers self-esteem, and embeds shame into the way they think about themselves.
When all your life the media portrays people who look like you as, say, not intelligent, the effect is profound. When people talk to you as if you're not intelligent, teachers seemed surprised when you say something smart, and your co-workers dismiss your ideas, it's easy for this notion that you're not smart to stick. Even without consciously realizing it, you begin to absorb the idea, and it affects your sense of self.
This process is called internalization. For marginalized people, internalizing society’s negative attitudes about them creates stress, lowers self-esteem, and embeds shame into the way they think about themselves. These disadvantages hang like a weight on Black Americans, making every achievement more difficult to reach, every leap of faith harder to take.
4. Racial trauma can be passed down through the generations
All of the above is happening upon the foundation of trauma passed down through generations. And I do mean "passed down” in a literal sense.
Trauma can be biologically transmitted across generations through a process scientists call epigenetics.
Slavery was, and racism continues to be, a chronic form of trauma. And trauma can be biologically transmitted across generations through a process scientists call epigenetics. Epigenetics boils down to environments and experiences “getting under the skin” by changing the way our genes are expressed and passed on.
For example, research has shown that trauma survivors’ children have altered flight-or-flight systems in their brains, similar to people who have PTSD. This makes these children more vulnerable to developing anxiety or trauma-related disorders themselves. This is part of why Black veterans are more likely to have PTSD than their white peers who served in the same wars.
This means that from Day Zero, there are more obstacles in the way of cultivating mental health for Black Americans.
And once they're born, Black children continue to inherit racial trauma by experiencing vicarious racism. When they witness someone like them being victims of discrimination or violence, they feel emotional pain for what their caregivers and role models are going through. They, at too young an age, also have to make sense of injustice in the world. Plus, when their caregivers have to deal with the burden and stress of experiencing racism, there is generally more negative emotion and stress to go around the household, making it even easier for these kids to have depressive or anxious symptoms.
5. Racism also prevents Black Americans from accessing and benefitting from mental healthcare
One barrier is Black Americans’ understandable fear of double discrimination. There is unfortunately still much stigma surrounding mental illness. If society is already prejudiced against you for the color of your skin, how would it act towards you when you say you also have a need for mental healthcare?
If society is already prejudiced against you for the color of your skin, how would it act towards you when you say you also have a need for mental healthcare?
This fear of stigma and discrimination is justifiable. Black Americans are more likely to be misdiagnosed with schizophrenia than their white peers with the same symptoms, which means they’re more likely to get the wrong treatment. This is in part because most providers are not well-trained in evaluating symptoms in the context of different cultural expressions, and in part because physicians tend to listen less and talk more when their patient is Black. Even after diagnosis, Black Americans are less likely than their white peers to receive evidence-based and guideline-consistent care.
Zooming out even more to Black Americans’ relationship with the overall healthcare system, it’s no wonder that many mistrust that system. Even scarier than microaggressions and misdiagnosis is the knowledge that, historically, medical researchers have exploited Black bodies.
In the Tuskegee Study, for example, Black men were told that they were being treated for syphilis, but they were misled—they never got proper treatment and were even withheld from effective treatments when those became available. How can people be blamed for being suspicious of the healthcare and research authorities, especially when something as vulnerable as mental health is concerned?
Even if a non-Black therapist is well-trained and well-meaning, a Black patient may wonder if this therapist will really understand their experiences.
And for Black Americans who are interested in seeking mental healthcare, are there enough good options? It’s already overwhelming for anyone to find a therapist, but when you go down the list and don’t see any providers who look like you, it can be extra discouraging. Even if a non-Black therapist is well-trained and well-meaning, a Black patient may wonder if this therapist will really understand their experiences.
Mental health resources for Black people
But there is hope. People have been paying more attention to Black mental health, and some leaders in the field have been pioneering initiatives to help. For example, Dr. Joy Harden Bradford, a licensed psychologist and popular speaker, has started a movement called Therapy For Black Girls. This is the name of her fantastic podcast, as well as the online space she has created to host resources and community to promote the mental wellness of Black women and girls.
For Black men and boys, there are resources too, starting with Souls of Black Men, a fact sheet based on conversations between Black men about mental health issues organized by the Black Mental Health Alliance for Education and Consultation. You can also learn more about programs focusing on Black men and boys' mental health at communityvoices.org.
Where do we go from here?
Looking back on what we’ve outlined today, it must feel discouraging to see how many monumental weights Black Americans carry in their work of cultivating mental health. Many of us non-Black people, especially those in positions of privilege, take certain things for granted—that doctors will listen, that there are therapists who understand our experiences, that we are born with a clean slate free from trauma, that we have access to the basic ingredients for mental health like the opportunity to sleep, and that the way we see ourselves—the way we teach our kids to see the world—is not colored by centuries of ongoing prejudice.
If your heart is broken, I won’t tell you to stop feeling sad. If you’re angry, I won’t tell you that you shouldn’t be furious.
If your heart is broken, I won’t tell you to stop feeling sad. If you’re angry, I won’t tell you that you shouldn’t be furious. If you experience racism, you have a right to the catharsis that strong emotions can offer. If you don't experience racism, let your emotions motivate you to do better, to learn more.
In the next two episodes in this Racism and Mental Health series, we’ll take a small step by reviewing some ways that Black and African Americans can protect their mental health from the toxic effects of racism as well as some ways that the rest of us can help.